Friday, November 30, 2007

Making the Switch

A lot of your comments from our last post got me thinking--it is really hard to switch from being a "high risk" infertility patient to a totally normal pregnant person. S. is having trouble doing this herself. Because in reality, she shouldn't have had "infertility"--she is 31, 30 when we started this, her cycles were perfect, her follicles and uterus perfect--there was clinically no reason why she couldn't get pregnant. But suddenly you do IVF and you are buttonholed into this bizarre high-risk category that we really want to get out of. In reality, we're minimalists when it comes to medical intervention. If it weren't for the infertility thing, we still would be.

So--how to you pick your hospital? Your midwife group? Or do you go with an actual OB because she knows what could happen to patients who conceive with IVF? I just don't know.

Our impression of our midwife group today was---pretty good, I would say. The midwife we talked to was super terrific--but there are 15 in that one practice, and we could have any one of them at any given appointment. I don't think the other midwife group we're interviewing operates that way, but I could be wrong. Also, we waited for like, 45 minutes, even though we had an appointment. We don't like that. But we acknowledge this is a big hospital and they are very busy.We were impressed by their stats, though--they deliver 400 babies per year (!) and out of those, have up to 9% c-section rate. Super-impressive. And a very low induction rate as well. They have a labor tub in the birthing center, but we haven't seen it yet and don't know if we'll like it as much as birthing center #1.


**Note: Yes, Stacey, you are totally right--I won't say "ACK!" anymore because it is a great decision to have to make. Hell, it's great we get to be the ones in charge of this decision in the first place!! I feel lucky to live in an area with so many great midwife practices and hospitals to choose from.


e. said...

we picked our MW through a referral of friends who had started with a different MW practice. they were in the ttc stage and doing IUIs. they had a very bad experience with the first practice and moved on. we started with the practice and pretty exclusively saw one MW, who is sort of a celebrity in the local lesbian / IUI needing community around here. she meet us before and/or after hours for IUIs, and was incredibly grounding through the whole ttc process for me.

now that i am preg, we have to face the reality that we'll get what ever MW is on-call at the birth. I believe there are 7 MWs in the practice and we've meet them all (save one - who is new and we are meeting next week and have subsequent appointments set up with her so we can get to know her well enough should we get her). there was only one MW i didn't like in the practice, but she's gone now - thus the new MW we're meeting.

i guess the whole thing was pretty easy for us because we didn't have to go to an RE and we were directed to this practice early on. if you have any where near the connection to your RE that we do to our MW, i can imagine how very hard it must be to switch.

good luck!

stacey said...

Don't say ack...these are great decisions to be facing.

Anonymous said...

Wow, you're so lucky to find a hospital with such great rates. I haven't even begun to do any research yet. I'd love to have a home birth, but the mister wants a hospital birth, and to be honest I'm more nervous about that than anything else!

orodemniades said...

Er, that was me, Oro.

Co said...

It's okay not to know and feel overwhelmed. It may help to remember that it's still early. You don't want to switch practices too late in the preg game, of course, but if you end up somewhere and aren't happy early on, you can certainly switch.

Definitely consider the Cesarean rates at the various hospitals. And as for birthing centers, you may want to find out ahead of time what things would result in you being transferred from a particular birthing center to a hospital (and to which hospital you'd be transferred if not obvious), since the advantages of a birthing center are only available to you if you get to stay there. I know in our area, if your water breaks and you're delivering at a birthing center, you actually only get x hours to deliver whereas at our hospital our MWs can give us more leeway in terms of time, just because we're in a hospital setting where a complication/infection can be more readily handled.

The 15-MW practice sounds potentially problematic only because of the size of it. I'd be less concerned about prenatal appointments than about having a MW whom you barely know, or maybe have never met, deliver your baby, unless they have enough MWs on call that that isn't likely to happen, or if you don't care so much about that. A smaller practice might be preferable for that reason.

We made our decision based on word of mouth and 3 consultation appointments... one with an OB and two with MW practices. You seem to want to go minimalist if possible in terms of interventions, so while it's important to ask about C-sec rates at the hospital and such, it's also important to find out how much autonomy a particular OB or MW would have at said hospital. At our hospital, we'd be pretty restricted except that our MWs have a good relationship with the hospital, have a lot of autonomy, and will be there with us from triage through birth. So, they will be able to protect us to some degree and we won't have to argue if I want to eat or drink or move around during labor. If we had a physician, who likely wouldn't show up until later in delivery, I'd have to show a note from my physician to be allowed to do those things. It's really stupid. So, anyway, I'd ask how long an OB or MW will be with you at the hospital, and if they're not available, who will be there in their place, what their philosophies are about anything that concerns you -- episiotomy, e.g.

Since you're concerned about the IVF thing, I'd also ask any MW practice what happens if you become high risk... to whom do they refer you... just to find out what the deal is.

These decisions are tough, but you'll make the right one. And I'm so excited that you guys are pregnant!!!!